Reflecting on the federal government’s implicit obesity strategy - most clearly revealed in the ongoing debate over whether to regulate advertising of junk food to children - of advocating personal responsibility, one might wonder why we would expect any progress on the obesity epidemic at all.

While our government may seek to convince you that obesity is really a private thing, a matter of “character” - and that you need to smarten up, eat less and get more exercise (a message of “If you are fat, get thin!”) - this unravels when you ask; how many people who are fat “choose” to be so, and if the number is high, why do all the diet companies do so well? As with smokers, the majority who are fat wish to quit their habit, but cannot.

There is no doubt that the problem is big: overweight and obesity afflict around two thirds of the Australian population and Access Economics estimated the total financial cost of obesity in Australia in 2005 to be nearly $4 billion. Yes, we should all do our bit but our federal government, and its loyal opposition, should smarten their act considerably as well. Neither has taken this pandemic seriously despite government action being essential to a solution.

The causes of the obesity pandemic were described eloquently recently by Professor Tim Lang and colleague Geoff Rayner from London’s City University food policy unit. They wrote of “the rise and rise of car culture and other advances marginalising daily physical activity; widening distances between homes and work or shops; the over consumption of food accompanied by its unprecedented, plentiful availability; the culture of clever and constant advertising flattering choice; the shift from meal-time eating to permanent grazing; the replacement of water by sugary soft drinks; the rising influence of large commercial concerns framing what is available and what sells.”

Given this complexity, obesity is a brilliant test of political capability. It is also a test for public health to think beyond its traditional boundaries. Unfortunately, as Lang and Rayner suggest, in response we have had a policy cacophony - too much noise, and too little harmony.

A forward thinking federal government would be looking to take a Cabinet-based approach to it - recruiting many portfolios beyond health to come up with a strategy. As for public health action, Lang and Rayner urge a rethink about obesity: they suggest an ecological approach to public health, and that “small, incremental, publicity driven changes [in individual behaviour] might suit the existing balance of policy interests, but what if … a more extensive, cross sectoral approach [involving agriculture, manufacturing, retail, education, culture, trade and economics] were more effective?”.

Many of the factors that underlie obesity have nothing whatever to do with “character”. Nor do they have much to do with the sickness services that dominate our health departments. Instead, they have everything to do with the political and economic organisation of our society, and hence are the proper domain of an intelligent responsible government. Mr Rudd, in his drive to the Lodge, has yet to articulate his policy about obesity: indeed, his response to the recent federal budget was entirely health-free.

Lang and Rayner highlight several “core truths” about obesity that those competing shortly for our vote would do well to consider:

• obesity is a rising problem among children worldwide;
• obesity leads to expensive medical problems - a private problem becomes public when we all pay for the medical care of people with complications of obesity;
• remedies based on individual action alone - diet plans, surgery or stigma - don’t work well and cost a bomb;
• there is a powerful temptation in government to limit actions to a choice-based, personalised approach, in part because this mirrors the commercial sector’s own approach, but also because a cross-society approach appears too big; and
• there is, as yet, no equivalent of the North Karelia project (in Finland, where community action, agricultural reform and health promotion led to dramatic falls in heart disease deaths).

In an ecological approach to obesity, government would indeed have a role - to focus attention on preventing weight gain (which applies to everyone and does not stigmatise those who already feel incompetent at solving their “weight problem”); to help make people feel secure to walk or ride a bike to work or school or for leisure; to negotiate and back some actions with food industries that lead to production and promotion of a food supply lower in energy density; and to investigate ways of controlling food costs for disadvantaged Australians, as well as to pursue planning functions to make physical activity routine.

These actions are likely to go much further than simply reminding people that being fat is unhealthy, and that they “ought” to have enough character to be thin.

As we tackle obesity, we need to recognise that it comes from multiple sources, that it is not a health portfolio problem alone, that more is needed than the current public health effort and we need to expand to take a more ecological, less health profession-dominated view of it. We have a long way to go: all the more reason to start right.